Progression of knee joint kinematics in children with cerebral palsy with and without rectus femoris transfers: a long-term follow up.

The purpose of this study was to compare long-term outcomes of multi-level surgery with and without rectus femoris transfer (RFT) in a group of children with cerebral palsy. Forty-one subjects with a diagnosis of cerebral palsy were divided into a RFT group (28 subjects with 50 sides) and non-RFT group (13 subjects with 22 sides). The study protocol included pre-operative gait analysis, multi-level orthopedic surgical intervention, one year post-operative gait analysis, and three year or greater post-operative gait analysis. All participants received inpatient physical therapy for 2-12 weeks either following surgery or following a period of immobilization, depending on surgical procedures performed. Results showed improved peak knee flexion during swing phase (PKFS) for the RFT group one year after surgery. The deviation from normal in PKFS in the RFT group improved, on average, from seven to five degrees. The deviation from normal in PKFS in the non-RFT group increased approximately four degrees in the same period of time. The knee flexion swing range (KFSR) of the RFT group increased dramatically by 11 degrees after surgery, where no significant KFSR changes observed in the non-RFT group. Those parameters maintained relatively stable from one to three years post surgery for both groups. These observations support our hypothesis that improvements after RFT surgery persist over time, counteracting the negative effects of growth and time.

Cigar smoking: an ignored public health threat.

Cigar smoking is rapidly increasing. Studies have exposed the move to cigar smoking by smokers who do not necessarily believe cigar smoking is risky behavior. However, cigar smoking poses significant risk that leads to well-documented morbidity and mortality. Currently, there is a dearth of primary prevention efforts related to cigar smoking. Furthermore, the literature is lacking in program, practice, and theory development as well as in the planning, execution, and evaluation of programs targeting cigar smoking cessation. A clear need exists to promote early prevention of cigar smoking, and to incorporate cigar smoking cessation into other tobacco cessation projects.